Organization Active NPI

Universal Wellness Source of Omaha LLC

  • Chiropractor
  • Elkhorn, NE
National Provider Identifier
1760092969
Registry record updated Apr 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
UNIVERSAL WELLNESS SOURCE OF OMAHA LLC
Practice address
5331 S 204TH Ave Ste 2
Elkhorn, NE 68022-4385
Phone
(531) 867-3720
NPI assigned
Aug 3, 2020
Last updated
Apr 28, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Kaylynne Gasiorowski, DCNPI 1558457747
Title
Owner
Phone
(402) 578-5133

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X Primary

Addresses

Primary practice location

5331 S 204TH Ave Ste 2
Elkhorn, NE 68022-4385

Mailing address

5501 S 208TH Cir
Elkhorn, NE 68022-3138

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200930000575 NE Part B Supplier - Clinic/Group Practice 4587083290 Receives reassigned benefits from 2 practitioners
Practice locations: Elkhorn, NE

National Provider Directory

National Provider Directory

Locations

5331 S 204th Ave
Ste 2
Elkhorn, NE 68022
Phone (531) 867-3720

2517 S 174th Plz
Omaha, NE 68130
Phone (402) 330-2225

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1596412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682640000000",
    "number": "1760092969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5501 S 208TH CIR",
            "city": "ELKHORN",
            "state": "NE",
            "postal_code": "680223138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5331 S 204TH AVE STE 2",
            "city": "ELKHORN",
            "state": "NE",
            "postal_code": "680224385",
            "telephone_number": "531-867-3720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSAL WELLNESS SOURCE OF OMAHA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-03",
        "last_updated": "2023-04-28",
        "certification_date": "2023-04-28",
        "status": "A",
        "authorized_official_last_name": "GASIOROWSKI",
        "authorized_official_first_name": "KAYLYNNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "402-578-5133",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elkhorn, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.